It was shocking when Moemin al-Mohammad died earlier this month after several hospitals declined to take the feverish toddler into their care.
The Health Ministry swiftly severed its ties with Tripoli’s Dar al-Shifaa Hospital, and public blame was laid at the doorstep of the institution that turned Moemin away once and where he eventually died. But the death of an uninsured child, appalling as it is, did not necessarily come as a surprise to those well acquainted with Lebanon’s flawed health care system. In between the publicized debacles, around half of the country’s population remains without health insurance, at risk of becoming the next tragedy.
Official statistics put the number of beds in public hospitals at 2,250. Sleiman Haroun, president of the Association of Private Hospitals, says the number is closer to 1,400. Either way, the health care arena is dominated by approximately 9,000 private beds and in most areas the closest emergency room is more likely to be private than public.
The Health Ministry pays for uninsured patients to be treated at private hospitals and many of the 2 million are admitted every day, but it also places a financial ceiling on each institution.
If a hospital surpasses the limit, as Haroun says Tripoli’s Dar al-Shifaa had, it is not supposed to admit patients unless they are in urgent need of care and cannot be moved elsewhere.
When Moemin’s father Khaled first brought his son to Dar al-Shifaa the day he died, Haroun says the child was deemed “transferrable.”
To admit his son, he would have had to pay approximately $1,000. There were similar problems at another institution, and a third didn’t have the facilities to treat the child. By the time the family collected the needed funds and returned to Dar al-Shifaa, Moemin was dying.
But Shadi Saleh, chair of the Department of Health Management and Public Policy at the American University of Beirut, cautions against turning the hospital into a scapegoat, given that several hospitals were involved and the wider system is at fault.
“In most countries of the world it is ethical practice that any hospital that has an emergency room should accept patients with emergency cases, irrespective of ability to pay,” he says.
Haroun says while mistakes may be revealed in the current investigation, “this baby died because of the stupidity of the system. Because we took things to the letter.”
Adamant that hospitals must admit emergency cases who can’t be moved, Haroun believes removing the “absurd” financial ceiling is the only way to fix a system that is clearly not functioning properly.
“We have to sit down together and address this problem to find something else. I don’t know yet what it is, but we must find something else.”
So what might this “something else” be? Almost exactly a year ago, Health Minister Ali Hasan Khalil promised that his plan to cover all uninsured Lebanese would be with the Cabinet “soon.”
But no such plan has yet made it to the Cabinet agenda and a Health Ministry source, who spoke on condition of anonymity, says it is currently under study by a ministerial committee, which is meeting regularly to hash out the details and figure out where funding will come from.
The plan, the source continues, aims to provide for hospitalization, medication for chronic illnesses, and checkups at ministry clinics.
Saleh suggests that anything less than a system that provides all citizens with health coverage is something of a Band-Aid for a clearly gaping wound:
“The only real solution for this is universal health coverage. Everything else that is done remains a short term solution that will not prevent something like this from happening again.”
Regardless of the potential cost, Saleh believes universal health care “is an issue of great importance, it’s an issue of national security. For many Lebanese, it is more important than what is being discussed now [by politicians] in terms of parliamentary election laws or salary modifications. I’m guessing that for most Lebanese having access to health care is one of their top priorities.”
For his part, Haroun deems universal health care a “utopia” and says it is likely unaffordable, but acknowledges that “we have failures in the system – we know where these failures are, and we need the government to take decisions to remedy these failures.”
While statistics on those who die because they are denied health care are only anecdotal, Saleh says, “If you look at this from a socioeconomic angle, it is going to be those who tend to be less educated, poorer.”
Aref Shukhaydem, the mayor of the Akkar village of Burj al-Arab where the Mohammad family lives and Khaled al-Mohammad serves in the municipal police, is now speaking for the grieving family.
“It is poverty that brought on this fate, and [Moemin’s father] is not even that poor,” he says. “He might have had money at home, he just didn’t have cash in his pocket. What about those who have no money at all?”
Shukhaydem says a doctor at Dar alShifaa went so far as to ask Moemin’s mother why she had three children, when she could not pay for their health care. The hospital has defended its conduct in several statements.
The family has pressed charges against several people involved in the incident, and the mayor now promises “we will not remain silent. We will keep raising our voice so that this won’t happen again to someone else.”
